| Objective:(1) To summarize the knowledge and the new researching development on IgA nephropathy of TCM. (2) By illustrating the basic TCM theory of branch and root, asthenia and sthenia, asthenia accompanied with sthenia on IgA nephropathy from microcosmic and macroscopical point of view by considering the pathologic damage, clinic manifestation and laboratory results to discuss the TCM essential and changing disciplinarian of IgA nephropathy. (3) To evaluate the TCM therapeutic efficacy for IgA nephropathy which is based on the differential diagnosis so as to provide further guidelines for clinical diagnosis and treatment. Method:(1)Literature study: to summarize and assess the researching situation of both TCM and western medicine on IgA nephropathy.(2)Study on patterns and their changing laws:(1) Through considering Memphis renal biopsy assessing system as the standard, and also taking the principal and secondary symptoms and signs of TCM differentiation standard for chronic nephritis as well as pathologic index to make an analyze on main elements and factors in order that the pathologic index which could best refer to the pattern could be chosen, then the regression analyze on the indexes and standard patterns could be made to have regression equations of every patterns. (2)Taking the principal and secondary symptoms and signs of TCM differentiation standard for chronic nephritis as standard, and also taking the main clinic manifestations(hematuria, lumbago, edema and hypertension) and laboratory results (urinary red cell, urinary protein, hemaurea nitrogen, hema cretinine, serum immunoglobulin A, complemen C, creatinine clearance rate) as indexes to make regression analyzes with every standard patterns so as to find out the regularity index which could well express the changing of patterns.(3) Treatment and evaluating the efficacy: 123 patients were chosenaccording to the including criteria and divided randomly into TCM group and western medicine group with TCM group is two times of western medicine group. TCM group were treated with herbal soup accompanied with Leigongteng tablets in accordance with differential classification aiming at treatment. Western medicine group were treated with conventional method. Treatment lasted at least 3 months and at most for 6 months for both groups. Comparison were made between two groups on over-all efficacy, efficacy of different level, symptoms and signs grading and side-effects. And comparison were also made between the start and the end of the study. Results:(1) Literature study.? TCM understanding: there is no corresponding name in TCM to IgA nephropathy; According to clinical manifestation, it can be classified into hematuria, lumbago, edema, consumptive disease, guange, dysuria. There are two kinds of cause for the disease, one is principal causes which are kidney and spleen deficiency, deficiency of Yin leads to hyperactivity of fire, Yand and Qi deficiency or damage of both Yin and Yang; the other is predisposing factors such as dampness and heat, hemostasis or attacked by exogenous evils, the essence of which are the root is asthenia and the branch is sthenia and the coexisting of asthenis and sthenia characterized with complicated etiology and long course. TCM therapy on IgA nephropathy has achieved good effects, and its treatment are based on three aspects, differentiating the stage, differentiating the pattern and specific formula. ?Understanding of modern medicine: IgA nephropathy is a kind of immune complex nephritis which is related to genetic and immune system insufficiency. The continuous sedimentation of IgA immune complex cause damage to glomerulus and activate the complements through by-pass, which result in accumulation of leucocyte, inflammatory cell activity or activation of glomerulus cells to release inflammatory factors and cytokine to damage glomerulus. Since there is no special and effective therapy for it, treatment generally focus on improving symptoms and signs and protecting renal function. It is advised to treat according to different types which are categorized by clinical manifestation and pathologic results.(2)Patterns and their changing laws: ? To analyze the main factors of 123 patients according to renal biopsy assessing system to find out the following factors that can reflect more than 85per change of glomeulus, they are glomerulus sclerosis, crescent, stroma, immunofluorescence IgA and C3 factors; to analyze the main factors based on TCM differentiating theory on primary glomerulonephritis to find out the following factors that can reflectmore than 90per change of glomeulus, deficiency pattern: tiresome; Yang deficiency pattern: extremities coldness, white, moist and smooth tongue fur, sunken and thread pulse; Yin deficiency pattern: dry feeling in mouth, red tongue and thread pulse; liver stagnation: impatient and tending to lose temper, bitter mouth, liable to heave a sigh and string pulse; hemostasis: dark tongue proper with hemostasis point; phlegm-wetness pattern: heavy feeling in extremities, fatty tongue fur, anorexia; heat and toxic pattern: sore throat, running sore, yellow and dry tongue fur; dampness and heat pattern: bitter and sticky mouth, fatty and yellow fur. (2) Regression analyze on main factors shows that: Yin deficiency pattern is related to mesangium cell proliferation, glomerulus sclerosis, Fg in immunofluorescence mesangium area and IgG in vascular area; Yang deficiency is related to glomeruius sclerosis, cytocrescent, non-fibrinous adhension, IgM and Fg in immunofluorescence mesangium area with necrosis; Yin and Yang deficiency are with fibrinous glomerulus or fibrinous crescent, fibrinous adhension and Fg in immunofluorescence vascular area. Speaking of sthenic patterns: hemostasis is related to damage of renal tubule and IgG in immunofluorescence mesangium area; heat and toxic pattern is related to mesangum cell increasing, cytocrescent, renal tubule damage and Fg in immunofluorescence area; dampness-phlegm pattern is with fibrinous glomerulus or fibrinous crescent, fibrinous adhensin and IgM in immunofluorescence mesangium area, Fg in vascular area; liver stagnation pattern is related to crescent, clq in immunofluorescence mesangium area and IgA in vascular area. ?Multiple regression and Logistic non-conditional regression analyze indicated that: Yang deficiency of TCM pattern is closely related edema, and the risk for Yang Deficiency in patient with edema is 1. 6 times than the patient without edema; Yin deficiency is related to hematuria, the more obvious the macroscopic hematuria is, the more severe the patient suffer from Yin deficiency, and the risk for Yin deficiency in patient with macroscopic hematuria is 1.5 times of that in patient without; whatever pattern may manifestate lumbago or soreness of loins.(3) Treatment and efficacy evaluation:?0ver~all efficacy: the efficacy of TCM group is 86.04% while that of western medicine group is 51.35%, P=0. 0001.?Efficacy of different grades: complete relieved patient in TCM group are 29(33.72%) and 4 (JO. 81%) in western medicine group, P--0. 016CXO. 05; significantly relieved patient in TCM group are 30(34.88%) and 5 (13.51%) in western medicine group, P=0. 0284<0. 05; improved patient in TCM group are15(17.44 % ) and 10 ( 27.03 % ) in western medicine group, P=0.3334>0. 05;non-effective patient in TCM group are 12(13.95%) and 18 (36.73 %) in western medicine group, P=0. 0001;(D Efficacy of different patterns: Yin deficiency pattern: complete relieved patient in TCM group are 18(36. 73%) and 0 (0%) in western medicine group; significantly relieved patient in TCM group are 18(36. 73%) and 1 (4. 55 %) in western medicine group; improved patient in TCM group are 10(20.41 %) and 7 (31.82%) in western medicine group; non-effective patient in TCM group are 3(6.12%) and 14 (63.64%) in western medicine group; Speaking of Yang deficiency pattern and both Yin and Yang deficiency patterns, detailed data could' t be gathered because the sample was not big enough. For Yang deficiency pattern, efficacy rate is 81. 25% in TCM groups and 83. 33% in western medicine groups, P = 0. 6116X1 05; For both Yang and Yin deficiency groups, efficacy rate is 71.42% in TCM groups and 66.67% in western medicine groups, P = 0. 8620>0. 05 o?Efficacy of syndromes and signs: comparison made between the start and the end of the study showed that there are significant difference in grading before and after treatment in TCM group whether asthenia or sthenia patterns. In western medicine group, no grading difference for Yin deficiency pattern, however, Yang deficiency asthenia pattern showed decrease in grading after treatment while sthenia pattern is opposite; both Yin and Yang deficiency pattern, Yang deficiency patients' grading reduced but Yin deficiency patients' grading went up and sthenia patterns also had the tendency of increasing. Comparison between two groups showed marked accretion whatever sthenia or asthenia?Toxicity and side-effects: No other side-effects has been detected except two of 86 patients in TCM group had temporarily menstrual disorder and resume normally after quitting Leigongteng tablet. However in western medicine group, 11 of 37 patients emerged with changes of different levels in TCM patterns, such as Yang deficiency relieved with Yin deficiency and dampness heat pattern increased after treated with hormone. Conclusion:(1) Glomerulus sclerosis, crescent, tubule atrophy, vascular pathologic changes, immunofluorescence IgA, C3 can reflect most of the changes in IgA nephropathy(85%), which will be great help for physicians in the treatment and prognosis prediction.(2) The pathology and clinic manifestation of IgA nephropathy is related to TCM differentiating patterns, which contribute to analyze and induce the... |
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